News & Analysis as of

Universal Health Services Inc v United States ex rel Escobar

Health Care Enforcement Quarterly Roundup - April 2018

by McDermott Will & Emery on

Over the past 18 months, we have closely monitored the Trump administration’s approach to health care enforcement issues, with a particular focus on whether prosecution of the False Claims Act (FCA) remains a priority under...more

3rd Circuit Reopens FCA Suit Over Pittsburgh’s Use of Federal Funds

by Weiner Brodsky Kider PC on

A three-judge panel of the U.S. Court of Appeals for the Third Circuit recently decided in a non-precedential opinion that a District Court judge erred in dismissing too quickly a False Claims Act (FCA) case in which fair...more

Enforcement and Litigation Strategies: Skadden’s Eighth Annual Pharmaceutical, Biotechnology and Medical Device Seminar

On March 15, 2018, Skadden hosted its Eighth Annual Pharmaceutical, Biotechnology and Medical Device Seminar in Palo Alto, California, which focused on U.S. enforcement issues faced by companies throughout the industry. The...more

FCA Materiality May Return to High Court

by Morrison & Foerster LLP on

In Escobar, the U.S. Supreme Court held that a defendant could be found liable under the False Claims Act for submitting impliedly false claims for payment. Under the implied certification theory of liability, a claim for...more

Healthcare Fraud & Abuse Review 2017

by Bass, Berry & Sims PLC on

A LOOK BACK... A LOOK AHEAD - While the uncertainty associated with legislative efforts to repeal the Patient Protection and Affordable Care Act (PPACA) dominated most of the headlines for the healthcare industry last year,...more

DOJ Memoranda Ushering in New Era for Health Care Enforcement

by Foley & Lardner LLP on

In January 2018, the Department of Justice (DOJ) issued two memoranda that, taken together, may usher in a new era of False Claims Act (FCA) enforcement in the health care industry. The first memorandum, dated January 10,...more

False Claims Act Alert - An Escobar Roundup: Falsity, Materiality, and Scienter

by WilmerHale on

In its June 2016 decision in Universal Health Services, Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016), the Supreme Court held that implied certification claims are viable under the False Claims Act (FCA), but...more

Escobar Pleading Standard Narrows Scope of FCA Allegations Against UnitedHealth Group

by King & Spalding on

The U.S. Department of Justice elected not to file a second amended complaint-in-intervention in U.S. ex rel. Poehling v. UnitedHealth Group Inc., 2:16-cv-08697, a Federal False Claims Act (FCA) case pending in the U.S....more

K&L Gates Triage: Triage in 2018: Health Care Topics to Watch in the New Year

by K&L Gates LLP on

We expect 2018 to be another year of rapid change within the health care industry. In this episode, Mary Beth Johnston highlights some of the key topics that the health care practice group will monitor in the coming year,...more

Health Update - February 2018

Hospitals and Health Systems Prepare for a Value-Based Future - Editor’s Note: Hospitals and health systems are actively working to service their communities in numerous ways, including through the adoption of initiatives...more

Federal Court Allows False Claims Act Case to Continue Against Medicare Advantage Insurer

by Holland & Knight LLP on

In February of 2018, a United States District Court in the Central District of California dismissed only half of the claims in a qui tam case against United Health Group, Inc. (UHG), a Medicare Advantage plan provider. United...more

Government Survives Dismissal of Remaining FCA Claims in Managed Care Case

by Bass, Berry & Sims PLC on

In U.S. ex rel. Poehling v. UnitedHealth Group, Inc., the U.S. District Court for the Central District of California partially granted UnitedHealth’s motion to dismiss the government’s FCA claims, which were based on the...more

Escobar Compels Florida District Court to Overturn $350 Million Jury Verdict Arising from Claims of Inadequate Documentation

Last month, a U.S. District Court in the Middle District of Florida overturned judgments totaling $347,864,285 returned by a jury under the federal False Claims Act (FCA) and Florida’s state equivalent against the owners and...more

Emerging Trends in False Claims Act Enforcement: 2018 Outlook

by Holland & Knight LLP on

• While financial recoveries under the federal False Claims Act (FCA) continued at a fast pace last year, the U.S. Department of Justice (DOJ) started 2018 with a proverbial "bang" by issuing new internal guidance directing...more

Court Vacates $350 Million FCA Jury Verdict under Escobar

by Weiner Brodsky Kider PC on

In an action brought by a relator under the False Claims Act, the U.S. District Court for the Middle District of Florida vacated a $350 million jury verdict, finding that the relator failed to provide proof that either the...more

Escobar’s Demanding Materiality Standard Nixes $350 Million Verdict Against Florida Nursing Facility

A Florida federal court threw out a $350 million jury verdict against a nursing facility, citing the Supreme Court’s landmark decision in Universal Health Services, Inc. v. United States ex rel. Escobar. The court explained...more

After Escobar, Materiality Matters

by Husch Blackwell LLP on

Contractors are now familiar with the Supreme Court’s June 2016 decision in Universal Health Services, Inc. v. United States ex rel. Escobar [PDF]. That decision recognizes False Claims Act liability for implied false...more

As Congress Struggles With ACA Repeal, Trump Administration Moves Forward With Regulatory Reform

The Trump administration and Republican-led Congress spent substantial time and political capital in 2017 on efforts to repeal and replace the Affordable Care Act (ACA) and enact sweeping Medicaid reform. By the end of the...more

False Claims Act: Implied Certification Theory

by Ropes & Gray LLP on

Kirsten Mayer, Ropes & Gray litigation & enforcement partner, examines the implied certification theory of liability under the False Claims Act. In 2016, the Supreme Court decided Universal Health Services v. U.S. ex rel....more

In Case You Missed It: Tracking Government Enforcement: The False Claims Act in 2017

The federal government continues to use the False Claims Act (FCA) as one of its prime enforcement tools against government contractors. To keep you informed on the status of the law, Bradley’s Government Enforcement and...more

ADG Insights: Top 2017 False Claims Act developments for ADG companies

by Hogan Lovells on

Through our monthly ADG Insights series, Hogan Lovells is pleased to share with you the top legal and political issues affecting the aerospace, defense, and government services (ADG) industry. Our ADG industry team monitors...more

Judge Cites Escobar Materiality Standard, Vacates $350 Million False Claims Act Judgment

by Jones Day on

The Situation: The False Claims Act imposes civil liability on any person or entity that "knowingly presents, or causes to be presented" to the U.S. government "a false or fraudulent claim for payment or approval." The...more

2017 – The Health Law Year in Review

Uncertain. What better word to describe a year in which a new administration came to power and began to chart a new course for health policy, the fate of the Affordable Care Act (ACA) hung in the balance, and courts grappled...more

Federal Court Strikes Massive False Claims Act Verdict Following Landmark Escobar Ruling

by Morgan Lewis on

The ruling in Universal Health Services, Inc. v. Escobar "rejects a system of government traps, zaps, and zingers that permits the government to retain the benefit of a substantially conforming good or service but to recover...more

Applying Escobar’s Materiality Standard, Florida Federal Court Reverses $350 Million False Claims Act Verdict against a Nursing...

by Dorsey & Whitney LLP on

If the government does not take action and continues to pay for Medicare/Medicaid claims after it learns of non-compliance related to the claims, is the non-compliance material to the government’s decision to pay? This is a...more

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